“Even when good workplace policies and support exist, without enough staff to meet essential patient needs, nurse fatigue cannot be properly addressed.”

Photo by Matthew Waring on Unsplash

When I was working as an ED nurse, if a colleague was out sick we’d invariably be asked to work a double shift—so, 16 hours instead of our usual eight-hour shift. It wasn’t bad as a one-time occurrence. But I can’t imagine how nurses have managed working five or more days of 12-hour shifts in a row, or even more, during the surges of Covid-19 patients needing hospitalization in various parts of this country. It’s no wonder there are so many stories and reports of nurses leaving the acute care setting.

While the obvious answer is that there needs to be more staff to share the work, not only to improve staff well-being but also to make care safer—and this is not a COVID-induced phenomena; we’ve known this for years thanks to research by Linda Aiken and others—getting that to happen has largely been unsuccessful.

Hospitals staff conservatively as a policy, causing many to be short-staffed on an almost ongoing basis. This makes for a stressful work environment that in turn causes nurses to leave, thus further exacerbating the problem. And along came the pandemic.

What we know about nurse fatigue, and what we can do.

In the December issue of AJN, nurses from the Fatigue Subgroup of the Health Behavior Expert Panel of the American Academy of Nursing provide a review of the evidence on nurse fatigue and several strategies—for nurses as well as for institutions—that can help mitigate it.

While the authors point out that addressing fatigue is a shared responsibility of both the individual nurse and the organization, they also note that, “[e]ven when good workplace policies and support exist, without enough staff to meet essential patient needs, nurse fatigue cannot be properly addressed.”

Why are nurses short-staffed?

I’ve spoken with some CNOs who say they’d hire staff in a minute if they could get them, but many nurses are not interested in staff jobs and instead are opting for the high wages being offered by travel nurse agencies. I’ve spoken with others who said the pandemic’s closure of elective procedures that bring in revenue decimated hospital budgets and they can’t afford to hire staff. A fact sheet from the American Hospital Association as early as late 2020 noted that three dozen hospitals had gone bankrupt since the start of the pandemic and the industry already estimated yearly losses at over $323 billion.

That said, hospital financing—and especially how budgets are allocated for nursing staff—needs to be revisited. Hospitals exist because people need nursing care and when the nurses leave, hospitals will close. We’ve recently seen a number of hospitals forced to shut down services and beds because of staff shortages.

In the interim, nurses need help to manage fatigue and hospitals need to do all they can to help until they can increase staffing. This article offers several suggestions. You can read it for free. Also listen to the podcast conversation with three of the authors.